AI Customer Service in Healthcare

Automate Complex Processes for a Better Patient Experience

HIPAA Compliance requires consistency, an area that Artificial Intelligence is exceptionally proficient.

Given the complexity of all that healthcare companies are dealing with, it can be hard to determine where call center automation fits on the priority list. Live agents have been a driving force for so long, but AI-powered customer service presents an opportunity for companies to differentiate their services and reduce operating expenses. Call Center AI can deliver HIPAA compliant, conversational self-service that adds convenience, improves agent effectiveness, and makes all stakeholders happy.
What we can automate for you

Challenges Facing Providers

  • Increasing demand for primary care providers (PCPs) as the national rate of uninsured persons falls
  • Compliance to heavy regulations and strict HIPAA requirements
  • Provision of consistent and cost-effective means of customer service
  • Patients want personalization in their care and assistance with complex requests
  • Receptionists spend much of their time repeatedly making outbound calls to either confirm appointments, uncover information for patients, or request authorization of certain services

Healthcare providers can use intelligent virtual agents to handle these processes:

Appointment Setting & Rescheduling

Voice self-service streamlines the entire appointment-setting and confirmation process: from the initial inbound scheduling call to the outbound confirmation calls and messages before the appointment. With 24-7 availability, omnichannel self-service:
Secure Omnichannel Call Center Automation Authenticates Customers
  • Frees up human resources from performing these tasks
  • Seamlessly sets up customer appointments
  • Reduces patient no-shows – and effort – as the constant reminder calls reiterate appointment details they may have missed or forgotten
  • Maximizes patient load as appointments become more consistent
  • Maintains strict HIPAA compliance by performing the same, rules-based process for every patient

Lab Results

Medical testing is stressful, and people want information as it becomes available. Call center automation reduces strain created by “status-check” calls, as it:
Omnichannel Call Center Automation is Capable of Securely Automating Credit Inquiries
  • Integrates with databases & accesses lab results in real-time to more accurately respond to patient queries
  • Frees up human resources to respond to more crucial and complex inquiries
  • Is HIPAA compliant
  • Maintains the human connection, as any abnormal results or reports that require human touch will be directed to live representatives
  • Performs backend processes (e.g. waiting on hold or navigating menu-based IVRs) to reduce agent time spent on the phone


Patients often want a wide range of options by which to pay invoices and outstanding balances for care. Intelligent automation provides the same experience in every secure channel and integrates quickly with any payment processing engine. With Conversational AI, you’ll:
Healthcare Payments Details
  • Accept full and partial payments, depending on patient preference and ability to pay
  • Enable both outbound and inbound payment processing
  • Reduce patient effort, making it simple and easy to keep up with their bills

Challenges Facing Payors

  • Increased regulation and weaker profit margins have prompted more consolidation and industry exit
  • Higher benefit expenses as the population continues to age
  • The need to cut costs in some areas to make up for other areas at risk of incurring even more cost
  • Providing a high-quality patient experience that promotes loyalty
  • Effective allocation of resources to higher priority patient situations

Healthcare payors can use intelligent virtual agents to handle these processes:


Prescriptions and treatments require pre-authorization for coverage, so providers and suppliers are often required to call and request these authorizations. Call center AI:
Customers can Make Payment Arrangements Securely using Omnichannel Call Center AI
  • Processes and responds to treatment requests effectively
  • Integrates case management systems, assigns case numbers, and allows payors easy access to the information for speedy decision-making
  • Allows patients to call in and check their pre-authorization status
  • Frees up your agents for the most complex, human-only inquiries

Claim Status

Checking on a claim is a low-value, high-volume operation for call center agents to be handling. AI-powered self-service:
Omnichannel Call Center AI Works With Customers to Minimize Risk of Default
  • Authenticates patients and scans their account for details
  • Summarizes the patient’s claim and offers more specific details when prompted
  • Emulates the services of an agent, helping to cut significant costs and improving the patient experience with no hold times and easier processes

Challenges Facing Medical Devices, Equipment, and Supplies Companies:

  • Callers “zero out” to agent right away
  • HIPAA compliance
  • Varied customer base (patients, providers, payors)
  • Outdated call center technology that frustrates customers

Medical Devices, Equipment, and Supplies Companies can use intelligent virtual agents to handle these processes:

Patient Authentication

Everyone that contacts Medical Equipment companies to place orders or review an account must be authenticated in a secure, HIPAA compliant way. Voice self-service is the ideal way to do this, as it:
Omnichannel Call Center AI Works With Customers to Minimize Risk of Default
  • Frees up human resources to perform high value tasks later in the patient journey
  • Authenticates patients faster and more easily than human agents
  • Creates opportunities for additional self-service processes

Order Status

As any DME supplier knows, order status in their business is not the same as in retail. The combination of insurance coverage (or Medicare/Medicaid) and the ongoing recurring orders they cover leads to higher agent involvement in the routine process of relaying order statuses. With dynamic, AI-powered call center automation:
Omnichannel Call Center AI Works With Customers to Minimize Risk of Default
  • Deliver the same information an agent would, but at a lower cost
  • Relay pertinent authorization details to patient, especially if order is not yet shipped
  • Integrate with third-party shipper systems to provide accurate delivery information

Patient Onboarding

There is a lot of paperwork involved when onboarding a new patient, with prescriptions, authorizations, and other certificates that all must be considered. Though this process is complex, it is business-rule driven and perfect for self-service. Omnichannel self-service:
Omnichannel Call Center AI Works With Customers to Minimize Risk of Default
  • Removes the costly, time-consuming, and tedious process from agent workload
  • Uses AI to deduce where a patient stands in the process and properly routes them
  • Take advantage of outbound service to make requests and deliver confirmations
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